Antiaging Eye Care and Aesthetics

Going beyond the traditional scope of primary eye care.

By Bridgitte Shen Lee, OD

The scope of primary eye care has grown beyond the typical vision and eye health examination. Older people today have active lifestyles, and more patients are asking about antiaging products and procedures during their annual eye examinations. By 2030, more than 20% of US residents will be age 65 years and older,1 and already today there are more than 100 million adults in the United States older than 50.1

On a daily basis, my patients ask about options to help them see and look their best. Because in many cases I have been taking care of their eyes for almost two decades, these patients trust me to recommend the latest innovations in antiaging eye care and to discuss aesthetic procedures. And as a busy working mom who is raising two children, running two businesses, and keeping up with my own emerging presbyopic body changes, I have been on the quest myself for effective antiaging products and nonsurgical procedures.

One of my favorite quotes is from the well-known and respected aesthetic dermatologist Doris Day, MD: “Growing old is a privilege, aging is optional! I help you look your best at every age.” This is a great sentiment describing what many of us do daily: helping patients to see and look their best.

How do we incorporate conversations on antiaging and aesthetics topics into our already busy schedules? The key is to build the antiaging eye care dream team: optometrist + refractive surgery ophthalmologist + aesthetic dermatologist + plastic surgeon. At my practice, Vision Optique, we have developed a simple three-tiered approach to antiaging eye care: (1) clear, comfortable vision; (2) healthy eyes; and (3) ocular and facial aesthetics. The educational information available to patients starts online on our website and various social media platforms, and the conversations continue in the examination rooms.

CLEAR, COMFORTABLE VISION

Our first job is to help patients see their best. Presbyopia affects approximately 120 million Americans today.2 Offering bifocals and reading glasses no longer suffices, as today’s presbyopic individuals lead busy lives, are tech-savvy, active in social media postings, and care about their appearance. Common complaints and frustrating annoyances include having to put on readers to see their smartphones and needing a flashlight to read a menu.

 

Presbyopic adults today want solutions that do not make them feel and look old. In addition, our patients want eye care solutions that help them to keep up with their demanding lives. People stare at various digital devices all day to connect with the world; it is estimated that 90% of Americans use multiple digital devices for more than 2 hours a day, and 65% experience digital eye strain (DES). DES is characterized by dry, irritated, and red eyes; blurred vision; headache; and neck, shoulder and back pain.3 More and more people are experiencing the effects of high-energy visible (HEV) blue light from digital devices and general lighting.

Fortunately, the optical industry has innovative solutions. There are no old eyes with the availability of digital nano-ophthalmic progressive lenses. There is no need for readers with the emergence of daily disposable multifocal contact lenses. There will be no tired and red eyes with the use of tear-infused silicone hydrogel daily disposable contact lenses. There is no need for glasses with refractive surgeries. And there is no DES when antifatigue digital lenses are combined with HEV blue light protection. The visual demands of living in the digital world are helping to drive a fast-growing vision care market. The total US vision care market generated about $34.5 billion in 2012.4 By 2022, that number is projected to reach $165 billion.5

HEALTHY EYES

Our second job is to make sure patients’ eyes are healthy and stay healthy. One of the most common complaints among the aging population is dry and red eyes. Dry eye disease (DED) is a multifactorial inflammatory disease of the tears and ocular surface that affects the eye’s ability to refract correctly and that, left untreated, can have a serious impact on functional vision, eye comfort and appearance, and patient quality of life.6 The three biggest risk factors for DED are age, diabetes, and digital device use.

In the United States, there are an estimated 30 million individuals with DED, and the number is growing. The $2 billion market for DED treatment is expected to grow to $2.5 billion by 2020, according to Market Scope.

DED is one of the main causes of ocular surface disease; comprehensive diagnosis and treatment of all causes are necessary to manage ocular surface disease. A better understanding of the roots of DED (evaporative and/or aqueous deficiency, medical, and environmental), innovative diagnostics, and more treatment options are allowing us to provide better quality of life to patients with DED. Those treatment options now include LipiFlow Thermal Pulsation System (TearScience), Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), Retaine MGD ophthalmic emulsion (OcuSoft), and Prevencia (HEV blue light protection coating, Essilor).

OCULAR AND FACIAL AESTHETICS

Older patients want to know what they can do to get rid of wrinkles, spots, bags, and sags. Once the conversation starts and patients realize that you are knowledgeable about aesthetics, then other topics, such as bulges and cellulite, are broached. It is helpful for optometrists to have a general knowledge of effective cosmetic procedures and to develop co-referral relationships with experienced board-certified cosmetic dermatologists and plastic surgeons who will help patients decide what’s best for them.

AntiAging Eye Care & Aesthetics

Antiaging Eye Care

1. No Old Eyes:  Essilor S Series, Zeiss Progressive Lens Individual 2, Hoyalux Id Mystyle

2. No Digital Eye Strain:  Essilor Eyezen, Hoya Sync, Zeiss Digital

3. No Tired Eyes:  Acuvue Oasys 1-Day With Hydraluxe, Dailies Total1, Myday

4. No Readers:  Biotrue Oneday For Presbyopia, 1-Day Acuvue Moist Multifocal, Clariti 1 Day Multifocal, Dailies® Aquacomfort Plus Multifocal

5. No Dry Eyes:  Lipiflow, Restasis®, Retaine Mgd

Antiaging Ocular Aesthetics

1. No Short Eyelashes:  Latisse & Zoria

2. No Wrinkles, Bags, And Aging Spots: Botox, Pellevé, Ipl

3. No Sagging:  Ultherapy, Thermismooth

Antiaging Body Aesthetics

1. No Bulges: Coolsculpting & Coolmini

2. No Dimples & Cellulite:  Cellfina

3. No Sweating:  Miradry Thermidry*

4. No Double Chin:  Coolmini And Kybella

5. No Thin Lips:  Juvéderm Volbella, Restylane Silk

6. No Hollow Cheeks: Juvéderm Voluma Xc, Restylane Lyft

Source: The American Society for Dermatologic Surgery

The growing global obsession with physical appearance is driving the aesthetics market. The global market for plastic surgery products is expected to exceed $15 billion by 2020, including $8 billion in the United States alone.7 In 2015, almost 10 million procedures were performed in this country. More than 3 million of these were medically necessary skin cancer treatments, and more than 6 million were aesthetic procedures all over the body, including 2.62 million laser or energy-based procedures, 1.79 million wrinkle-relaxing injections, 1.36 million soft-tissue fillers, 600,000 chemical peels, and 230,000 body sculpting procedures.8

The number of nonphysicians operating lasers is increasing, particularly outside of a traditional medical system. Patients should be aware that laser treatments are medical procedures and should verify the training, certification, and experience of the person performing the procedure.9 Increases in harmful complications resulting from the non-physician practice of dermatologic and cosmetic procedures have been reported nationally.10 Optometrists can help to reduce these serious complications by referring patients to experienced dermatologic and plastic surgeons.

M. Christine Lee, MD, is a dermatologic surgeon and director of The Skin and Laser Treatment Institute in Walnut Creek, California. Paul Friedman, MD, is the director of Dermatology & Laser Surgery Center in Houston, Texas, who also practices at the Laser & Skin Surgery Center of New York. They have advised on the next section which describes top minimally invasive laser procedures.

No Short Eyelashes: Latisse and Zoria. Latisse (bimatoprost ophthalmic solution 0.03%; Allergan) is a prescription prostaglandin analogue indicated to treat hypotrichosis of the eyelashes by increasing their growth. It has the same active ingredient as the glaucoma drug Lumigan (Allergan). Latisse helps to lengthen and thicken eyelashes, although it carries the risk of potential (but reversible) side effects such as increased iris and periorbital pigmentation.

Zoria Boost Lash-Intensifying Serum (OcuSoft) utilizes patented polypeptide technology to naturally enhance and support the eyelash growth cycle for longer and darker eyelashes. It is a drug-free formula without the potential side effects of Latisse. Latisse and Zoria work well for the right patients, and optometrists can prescribe Latisse and sell Zoria.

No Wrinkles, Bags, Aging Spots: Botox, Fraxel, KTP and Nd:YAG. Botox (onabotulinumtoxinA; Allergan) is a neuromuscular blocking agent with multiple indications, in and outside of eye care. For aesthetic purposes, this neurotoxin can be used to temporarily improve the look of moderate to severe crow’s feet and frown lines between the eyebrows by paralyzing the muscles in the face and around the eyes.

Fraxel utilizes non-invasive laser technology to stimulate collagen and resurface the top skin layer. It helps reverse the visible effects of aging, such as fine lines and wrinkles, surface scarring from acne, hyperpigmentation, sun damage, and actinic keratosis.

The gold standard for treating vascular and pigmented lesions, according to Dr. Lee, is a combination KTP and Nd:YAG laser which she helped to develop. Lasers are more effective for targeting individual lesions because they penetrate deeper and are more specific for the chromophore (light absorbing molecule) in the individual lesion.  Having a smaller spot size also allows for precise concentration of the laser energy on the targeted lesion.11

No Sagging: Ultherapy, ThermiSmooth, Thermage. Ultherapy (Ulthera) is a noninvasive ultrasound treatment that stimulates collagen production at the level of the dermis. ThermiSmooth Face (Thermi) uses temperature controlled radiofrequency energy to stimulate collagen remodeling. Thermage is a non-invasive radiofrequency therapy that helps to improve the appearance of sagging or loose skin. These technologies help the skin on the face to tighten and tone, thereby improving the appearance of lines and wrinkles.

No Double Chin: Kybella, CoolMini. Kybella (deoxycholic acid injection 10 mg/mL, Allergan), injected into the fat located in the chin, begins breaking down the fat. The active ingredient is a naturally occurring molecule in the body that aids in the breakdown and absorption of dietary fat.

CoolMini (Zeltiq) is an applicator for a procedure called Coolsculpting, a nonsurgical technique that freezes fat cells with the application of a controlled cooling system. Once the fat cells become crystallized, they die. Over time the body eliminates the dead fat cells, creating a more sculpted appearance in the treated area.

No Thin Lips: Juvéderm Volbella, Restylane Silk, Belotero. Juvéderm Volbella injectable gel (Allergan) uses the patented Vycross technology (Allergan) that incorporates short and long chain hyaluronic acid crosslinking. It helps restore fullness and shape to the lips. Volbella is the newest addition which will be available in October 2016.

Restylane Silk injectable gel (Galderma Laboratories) helps to smooth out the wrinkles around the mouth and enhance the size and shape of the lips. This product uses a clear gel formulation of hyaluronic acid that acts similarly to the body’s naturally produced hyaluronic acid to plump and shape the lips.

Belotero is another favorite filler to use around the eyes and lips. Dr. Lee says “it has unique crosslinking that creates a lower viscosity gel that goes in smoother and softer than other hyaluronic acids, making it ideal for thinner skin areas like the eyes and lips.”

No Hollow Cheeks: Juvéderm Voluma, Restylane Lyft. Juvéderm Voluma XC injectable gel (Allergan) is another member of the Juvéderm family of fillers; it is used to add volume beneath the skin’s surface to lift and contour the cheek area. Restylane Lyft injectable gel (Galderma Laboratories) is another hyaluronic acid gel indicated to help correct volume loss and treat wrinkles in the face.

AESTHETIC BODY CARE

Beyond their eyes, patients also want insights into aesthetic body procedures in general.

No Bulges: CoolSculpting & Vanquish (BTL) combined with Exilis (BTL) or TightSculpt (Fotona). CoolSculpting is a procedure that targets fat areas by vacuuming and freezing fat cells through the application of a controlled cooling system, creating a more sculpted treated body area.

Vanquish is a multipolar radiofrequency device that melts fat that can be used all over the body and has a special applicator that can be used specifically on the arms and legs.  Exilis is a monopolar radiofrequency device that tightens the skin and does body contouring.  TightSculpt is the latest skin tightening and body contouring device from Fotona which is an attachment to the SP Dynamis Pro.

No Dimples and Cellulite: Cellfina. The Cellfina System (Ulthera) relies on a minimally invasive needle-sized device to treat the primary structural cause of cellulite. Tight connective bands woven throughout fat in the thighs and buttocks pull down on the skin, creating puckering on the surface of the skin. During treatment, these tight bands are broken, causing the treated skin to smooth out.

No Sweating: miraDry, THERMIdry. With the miraDry System (Miramar Labs), microwave radiation is applied to the underarm to treat axillary hyperhidrosis (excessive armpit sweating), creating a focal energy zone of heat to obliterate the sweat glands. ThermiDry (Thermi) applies controlled heat to the sweat glands using radiofrequency energy under local anesthesia to disable the glands from functioning.

OPPORTUNITIES

Beauty begins with the eyes! It’s an exciting time for optometrists to be a part of the integrated aesthetic medicine team that encompasses eye care, skin care, and cosmetic and plastic surgery procedures!  When the antiaging aesthetic dream team (optometrist, ophthalmologist, aesthetic dermatologist, plastic surgeon) collaborate together to educate patients, the result is happy patients and healthy practices! n

1. Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. U.S. Census Bureau. May 2014. http://www.census.gov/prod/2014pubs/p25-1140.pdf. Accessed June 24, 2016.

2. The Vision Council. Digital Eye Strain Report 2016. http://www.thevisioncouncil.org/digital-eye-strain-report-2016. Accessed June 24, 2016.

3. Statistics and facts on the eyewear industry in the U.S. Statista. http://www.statista.com/topics/1470/eyewear-in-the-us/. Accessed June 24, 2016.

4. Global Market Insights. Eyewear Market Size forecast to reach USD 165 Billion by 2022. Nasdaq GlobeNewswire. March 28, 2016. https://globenewswire.com/news-release/2016/03/28/823217/0/en/Eyewear-Market-Size-forecast-to-reach-USD-165-Billion-by-2022-Global-Market-Insights-Inc.html. Accessed June 24, 2016.

5. AARP. Getting to know Americans age 50+. . 2014. http://www.aarp.org/content/dam/aarp/research/surveys_statistics/general/2014/Getting-to-Know-Americans-Age-50-Plus-Demographics-AARP-res-gen.pdf. Accessed June 24, 2016.

6. [no authors listed] The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5(2):75-92.

7. AestheticsWire. Global plastic surgery market set to boom. April 22, 2016. http://modernaesthetics.com/wire/view.asp?20160422-global_plastic_surgery_market_set_to_boom. Accessed June 24, 2016.

8. American Society for Dermatologic Surgery. ASDS survey: Nearly 10 million treatments performed in 2015. May 5, 2016. https://www.asds.net/_Media.aspx?id=9449&terms=survey. Accessed June 24, 2016.

9. Friedman PM, Jih MH, Burns A, et al. Nonphysician practice of dermatologic surgery: the Texas perspective. Dermatol Surg. June 2004. https://www.dermlasersurgery.com/wp-content/uploads/pdf/Nonphysician_practice.pdf

10. University of California, Los Angeles (UCLA), Health Sciences. “Lawsuits increasing over skin-related laser surgery performed by non-physicians.” ScienceDaily. ScienceDaily, 17 October 2013. www.sciencedaily.com/releases/2013/10/131017093507.htm.

11. Lee MC. Combination 532-nm and 1064-nm lasers for noninvasive skin rejuvenation and toning. Arch Dermatol. 2003;139(10):1265-1276.

Bridgitte Shen Lee, OD
• Cofounder and CEO, Vision Optique, Houston, Texas
• Founder and consultant, iTravelCE
• 832-390-1393; drbshenlee@iTravelCE.com
• Financial disclosure: consultant to Essilor, Johnson & Johnson Vision Care, Bausch + Lomb, OCuSoft, Guardion Health Sciences